System and Method for Rapid ECG Acquisition

ABSTRACT

In one embodiment, an ECG monitoring system includes two or more electrodes configured to record cardiac potentials from a patient, at least one processor, and a rapid acquisition module executable on the at least one processor to: determine that an impedance of each electrode is less than an impedance threshold; record initial ECG lead data based on the cardiac potentials; determine that a noise level in each ECG lead of the initial ECG data is less than a noise threshold; start a recording timer once the noise level is below the noise threshold; record an ECG dataset while the noise level is maintained below the noise threshold until the recording timer reaches a predetermined test duration; store the ECG dataset and provide a completion alert.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.15/189,810, filed Jun. 22, 2016, which is incorporated herein byreference in entirety.

BACKGROUND

This disclosure generally relates to medical monitoring systems anddevices, and more specifically to a method and system for ECGmonitoring.

Electrocardiograms (ECGs) are graphic depictions of electrical activityin the heart. ECGs are produced by electrocardiographs which areavailable as stand alone devices, portable devices, and/or as integratedfunctions in various types of multi-vital sign monitoring devices. ECGsare depicted by time (ms) versus voltage (μV) and typically arerepresented as a waveform. The typical five important aspects, orportions, of an ECG waveform are the P wave, QRS complex (represented asthe combination of the Q, R, and S waves respectively), and T wave. Theless frequently seen sixth portion is a U wave. The data produced fromthe graphical depictions are useful in diagnosis of patients todetermine what, if any, and the extent to which heart-related problemsexist in a patient. For instance, ECGs are used in diagnosing: cardiacarrhythmias (irregular heart rhythms), myocardial infarction (heartattacks), hyper- and hypokalemia (high or low potassium levels,respectively), blockage, ischemia (loss of oxygen due to lack of bloodflow possibly from blockage), just to name a few, and may also assist indiagnosis of non-heart related ailments. Accordingly, ECGs are known andproven to be valuable tools in diagnosis heart and evennon-heart-related problems with patients.

Particularly, the ECG waveforms are useful in determining whethercertain conditions exist or the predisposition of such conditionsoccurring based on established patterns. Particularly, importantinformation can be derived by measuring the time between certainwaveforms; commonly reviewed time intervals are those between the P waveand the beginning of the QRS interval (known as the PR interval) and thetime between the QRS complex and the T wave (known as the QT interval.Other relevant data may be derived from the PR segment, the QRS complex,and the ST segment.

Typically, ECGs are used as diagnostic tools in various settings, suchas hospitals and doctors offices. Oftentimes, it is important forreliable ECGs to be obtained as quickly as possible, such as inemergency situations or even in busy clinical settings.

SUMMARY

This Summary is provided to introduce a selection of concepts that arefurther described below in the Detailed Description. This Summary is notintended to identify key or essential features of the claimed subjectmatter, nor is it intended to be used as an aid in limiting the scope ofthe claimed subject matter.

In one embodiment, an ECG monitoring system includes two or moreelectrodes configured to record cardiac potentials from a patient, atleast one processor, and a rapid acquisition module executable on the atleast one processor to: determine that an impedance of each electrode isless than an impedance threshold; record initial ECG lead data from eachlead in a predefined lead set among the two or more electrodes;determine that a noise level in the ECG data recorded in each lead isless than a noise threshold; start a recording timer once the noiselevel is below the noise threshold; record an ECG dataset while thenoise level is maintained below the noise threshold until the recordingtimer reaches a predetermined test duration; store the ECG dataset andprovide a completion alert.

One embodiment of a method of monitoring ECG includes determining thatan impedance of each of two or more electrodes is less than an impedancethreshold and recording an initial ECG lead data with a processor fromeach lead in a predefined lead set between the two or more electrodes.The method further includes determining that a noise level in theinitial ECG lead data recorded in each lead is less than a noisethreshold, starting a recording timer once the noise level is below thenoise threshold, and recording an ECG dataset while the noise level ismaintained below the noise threshold until the recording timer reaches apredetermined test duration. The ECG dataset is then stored in memoryand a completion alert is generated.

Another embodiment of an ECG monitoring system includes a means fordetermining that an impedance of each electrode is less than animpedance threshold and that a noise level in an initial ECG lead datarecorded from each lead in a lead set is less than a noise threshold.The ECG monitoring system further includes a means for automaticallyrecording an ECG dataset of a predetermined test duration while theimpedance is maintained below the impedance threshold and the noiselevel is maintained below the noise threshold. The ECG monitoring systemfurther includes a means for storing the ECG dataset in memory and ameans for generating a completion alert.

Various other features, objects, and advantages of the invention will bemade apparent from the following description taken together with thedrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure is described with reference to the followingFigures.

FIG. 1 depicts one embodiment of an ECG monitoring system according tothe present disclosure.

FIG. 2 depicts one embodiment of a computing system incorporated in anECG monitoring system according to the present disclosure.

FIG. 3 depicts one embodiment of a method of monitoring ECG according tothe present disclosure.

FIGS. 4A and 4B depict another exemplary embodiment of a method ofmonitoring ECG according to the present disclosure.

DETAILED DESCRIPTION

Through their experimentation and research in the relevant field, thepresent inventors have recognized that a need exists in the relevantfield for an ECG monitoring system and method that collects and obtainsreliable ECG data as quickly as possible. Currently available ECGmonitoring systems and methods may offer functionality that locates andextracts optimal ECG data from a large ECG dataset 40, such as wherecardiac potentials are recorded over a period of time, such as a periodof minutes, and the data is reviewed to select the best portion uponwhich to perform cardiac-related data analysis. This method ofperforming a test often requires the user to acquire more data than isnecessary and be attentive to observing the waveform so that they areconfident to have sufficient data quality. Such systems often take toolong to obtain the needed ECG data and also require too much involvementby the clinician performing the test.

A person having ordinary skill in the art will recognize that all ECGelectrodes require a period of time to obtain a good connection betweenthe patient's skin and the electrodes, often referred to as “settlingtime.” During settling time, the noise level in the leads will behigher, and as the electrodes settle the noise level will decrease. Theinterface impedance between the patient and the electrode, and thus thenoise level, reduces relatively rapidly in the first few minutes afterapplication, and the values tend to level out after the settling time.Several variables play into the amount of settling time required beforereliable ECG data can be obtained, such as electrode type, a patient'sskin chemistry, a patient's age, a patient's condition (such as whetherthey have poor circulation, are sweating, etc.), or the like.

In currently available systems, a clinician must monitor the ECGwaveforms on the patient in order to determine when the settling processhas completed and the ECG recording can commence. Further, it may notalways be easy or possible for a clinician to immediately determine whenthe settling period has completed and the noise level due to electrodeimpedance has reached an adequate level for recording to commence. Theinventors have recognized that this task of monitoring leads during theelectrode settling process occupies valuable clinician time andattention, which could be directed to other tasks.

The inventors have recognized that a system for rapid identification ofwhen the settling has sufficiently completed in order to obtain reliableECG data can expedite the ECG testing process, not only to eliminateunnecessary waiting time where the clinician is unable to immediatelyidentify that the settling process has sufficiently complete, but toeliminate incidents where retests are required as a result of performingthe test prematurely. In emergency room settings, for example, prematuredata acquisition can cause significant delays because the clinicianoften is unable to determine that the ECG data is unreliable until aftercompletion of the ECG test and analysis of the ECG dataset. At thatpoint, the test will need to be redone and significant time is wasted.Accordingly, the inventors have developed the disclosed system basedfurther on their recognition of this problem in order to guarantee thatyou will end up with clean data as quickly as possible.

Accordingly, in view of their recognition of the shortcomings ofpresently available ECG monitoring systems and methods and therecognition of a need for an ECG monitoring system and method that thatautomatically recognizes when the settling process is completed andobtains reliable ECGs as quickly as possible and with minimalinvolvement by a clinician, the presently disclosed system and methodwas developed. For example, the systems and methods disclosed hereinautomatically monitor the signal quality in each lead to provide theearliest available ECG meeting certain predefined quality standards.

As disclosed herein, the ECG monitoring system and method, which may beembodied in a software program, operates to automatically obtain theearliest reliable ECG dataset 40, and to automatically analyze the ECGdataset 40 without the need for intervention by the clinician. Acompletion alert is provided or automatically presented to the clinicianwhen the test is completed, which may include presenting the analysisresults. Accordingly, a clinician using the presently disclosed systemand method can connect the electrodes to the patient and then turn theirattention to other tasks relating to the patient care, such asadministrative tasks involved in the ECG testing process. The systemthen automatically determines when the electrodes have reached theirsettling point and when the earliest reliable ECG data can be obtained,and then automatically records and analyses the first available reliableECG data. In certain embodiments, the system and method may includerunning a settling timer that monitors how long the system looks forreliable ECG data and provides a failure alert to a clinician ifreliable data is not located within a predetermined attempt duration,which may be adjustable by a user to be appropriate for the clinicalsetting in which the method and system is employed.

FIG. 1 depicts one embodiment of an ECG monitoring system 1 comprisingthree ECG electrodes 6 connected to an input port 9 of a monitor 4.While the example of FIG. 1 depicts an embodiment including threeelectrodes, a person of ordinary skill in the art will understand inlight of this disclosure that the system 1 may include any number of twoor more electrodes, and that common electrode arrangements for standarddiagnostic ECGs include anywhere from three to fourteen electrodes with10 electrodes being the most commonly used electrode configuration fordiagnostic ECGs. As described in more detail herein, the system 1 alsoincludes a user interface 14 connected to the monitor 4 to receivecontrol inputs from a user, such as a clinician administering an ECG toa patient, and to provide auditory or visual outputs to the user.Accordingly, the user interface 14 including a display 15 and a speaker17. The user interface 14 may be a separate device that is electricallyor wirelessly connected to the monitor, or the user interface 14 may beintegrated with the monitor 4, such as within the same housing.Alternatively, the user interface may include a printer that may be usedas an output device to produce a printed form of the ECG dataset as thedisplay.

The cardiac potentials recorded by the electrodes 6 are then processedby the signal processing circuit 112, which includes one or moreamplifiers 113 and one or more analog-to-digital converters 114. Forexample, the amplifier 113 may be a differential amplifier that comparespotentials measured by various electrodes 6, or compares the potentialsmeasured at each electrode to a reference input (such as ground or anactive drive voltage) to derive a signal which is then utilized by thecomputing system 100 to generate the ECG lead signals. The output fromthe amplifier 113 is digitized by the analog-to-digital converter (A/Dconverter) 114. The A/D converter 114 may be any device or logic setcapable of digitizing analog physiological signals at an appropriatesampling rate. For example, the A/D converter 114 may be an analog frontend (AFE). The signal processing circuit 112 may include multipleamplifiers 113 and A/D converters 114, such as one for each electrode inthe system 1. For example, a 10 electrode set is configured so that oneelectrode is connected to a ground reference and the remaining 9electrodes are used as inputs to 8 amplifiers and are digitized by 8 A/Dconverters to generate signals from which a standard 12-lead ECG isderived.

The output of the signal processing circuit 112 is received by thecomputing system 100 within the monitor 4. The computing system 100includes one or more processors 106 and storage system 104 comprisingcomputer memory. A rapid acquisition module 11 is stored within storagesystem 104, which is a set of software instructions executable by theprocessor 106 to determine when the electrodes have settled andautomatically record an ECG dataset 40 of a predetermined length, ortest duration, at the earliest time when valid and reliable ECG data isavailable.

In one embodiment, the rapid acquisition module 11 further receives animpedance of each electrode 6 and is executable on the processor 106 todetermine that the impedance of each electrode is less than an impedancethreshold. A person of ordinary skill in the art reviewing thisdisclosure will understand that impedance is typically measured betweeneach sensing electrode and a reference electrode. As an example, in manyelectrode configurations the right leg (RL) electrode is connected toground or an active drive circuit and serves as the reference point fromwhich the impedance of the remaining electrodes is measured. Theimpedance threshold is a predetermined impedance amount below which theelectrode can be assumed to be fully attached, or fixed, to a patient,such as adhered to a patient's skin. In various embodiments, a singleimpedance threshold may be set for each and every electrode 6 in the ECGmonitoring system 1, or various impedance thresholds may be set forvarious electrode locations or electrode types, such as to account forexpected variances in impedance at different locations on the patient'sbody or types of electrodes that may be used on the patient's body inparticular applications.

Once the rapid acquisition module 11 determines that the impedance 32 ofeach electrode 6 is less than the impedance threshold, then it begins togenerate initial ECG lead data based on the cardiac potentials obtainedfrom each electrode 6. The initial ECG lead data may include all of thepredefined set of ECG leads generated for the ECG (e.g., all 12 leads ina 12-lead ECG), or may be a predetermined subset thereof that isrepresentative of the ECG dataset or most critical for obtaining areliable ECG test (e.g., only the precordial leads or some other subsetof the 12 leads are assessed for the noise level determination). Therapid acquisition module 11 further includes instructions executable tocalculate a noise level in the initial ECG lead data, and compare thecalculated noise level to a noise threshold. Accordingly, the rapidacquisition module 11 determines when a noise level in the initial ECGlead data recorded in each lead is less than the noise threshold. Forexample, the noise level determination may include calculation of asignal-to-noise ratio and determination that the signal-to-noise ratiois less than a threshold signal-to-noise ratio. For instance, thedetermination of the signal-to-noise ratio may include measurement ofthe QRS amplitude compared to a noise amplitude. The noise thresholdvalue may be set the same for each lead, or various noise thresholds maybe set for the leads in the predefined lead set, such as to account forvarious noise levels that might be expected in certain leads and/orapplications.

The goal within the rapid acquisition module 11 is to determine when thesettling process is complete and when is the earliest appropriate timeto record an ECG dataset 40. In certain embodiments where the need foran immediate ECG dataset 40 outweighs the need for clean data in eachlead, the rapid acquisition module 11 may be configured to beginrecording an ECG dataset 40 when the noise level in just a subset of theleads in the lead set are below the respective noise thresholds

Once the rapid acquisition module 11 has recognized that sufficientsignal quality is presented in the respective leads, a recording timeris started and the rapid acquisition module 11 begins gathering an ECGdataset 40, with the aim of gathering data for a predetermined testduration while the signal quality remains good. The test duration 34 maybe set by the clinician prior to or upon connecting the electrode 6 tothe patient, or it may be a fixed standard value, such as a ten secondECG recording. Once an ECG dataset 40 has been automatically recordedthat meets the noise level requirements, such as while the noise levelin each lead is less than the noise threshold for that lead and/or belowa general noise level threshold set for all leads, the ECG dataset 40 isstored, such as within the memory of the storage system 104, and acompletion alert 42 is provided. For example, the completion alert 42may be an auditory alert via the speaker 17, or a visual alert on thedisplay 15. For example, the completion alert 42 may comprise or includeautomatically displaying the ECG dataset 40 on the display 15 forassessment by the clinician. Alternatively or additionally, thecompletion alert 42 may comprise a textual or other visual alertnotifying the clinician that an ECG dataset 40 has been acquired, andsuch alert may require the clinician to take affirmative action to viewthe ECG dataset 40 and/or analysis results 44 determined therefrom. Inone embodiment, the rapid acquisition module 11 automatically andimmediately analyses the ECG dataset 40 upon completion of therecording, and such analysis results may be immediately provided to theclinician after generation of the completion alert 42 or as part of thecompletion alert 42.

The rapid acquisition module 11 may further be configured to receive anacceptance or rejection 38 of the ECG dataset 40 from the clinician. Forexample, the rapid acquisition module 11 may control the display 15 topresent an option to the clinician to accept or reject the ECG dataset40 that was automatically recorded. For example, such acceptance orrejection 38 inputs may be provided by the clinician through userinterface 14. If the rapid acquisition module 11 receives a rejection 38of a recorded ECG dataset 40, it may restart the recording timer andrecord a second ECG dataset, again executing instructions to find thefirst available dataset 40 of the test duration 34 that meets the noisethreshold requirements. A second completion alert is then generated andthe clinician can again accept or reject the second ECG dataset 40.

The rapid acquisition module may be configured so that it only attemptsto automatically record an ECG dataset for a predetermined attemptduration, which may be adjustable by a user via the user interface 14.Specifically, the user may input an attempt duration 36 before or uponconnecting the electrode 6 to the patient, and thereby can customize therapid acquisition module 11 based on the situation or setting in whichthe ECG monitoring system 1 is being used. For example, in an emergencysetting, the attempt duration may be set low, such as to five minutes orless, and in a clinical setting may be set higher, such as to tenminutes, fifteen minutes, or more. The attempt duration 36 may furtherbe set by the clinician based on the type of electrodes that are beingemployed because different electrode types have different settlingtimes, or based on the patient's condition. To this end, the rapidacquisition module 11 may be executable to start a settling timer oncethe impedance of each electrode 6 is determined to be less than theimpedance threshold, and thus once the electrodes 6 are determined to befully connected to the patient. Upon starting the settling timer, therapid acquisition module 11 begins recording the initial ECG lead datafrom each lead and assessing the noise level and/or other signal qualitymeasures as described above. In the instance where no ECG dataset 40 isobtained before the settling timer reaches the attempt duration, therapid acquisition module 11 may generate a failure alert 46, which maybe an auditory alert via speaker 17 or a visual alert provided on thedisplay 15. Further, the rapid acquisition module 11 may further beconfigured to automatically record an ECG dataset once the settlingtimer reaches the attempt duration. For example, upon expiration of theattempt duration, the rapid acquisition module 11 may start therecording timer and record the ECG dataset 40 until the recording timerreaches the test duration. In another embodiment, once the attemptduration has expired, the rapid acquisition module 11 may examine abuffer of the recently recorded data to find the section of data havinga length equal to the test duration that is the least noisy section ofdata, e.g., having the lowest signal-to-noise ratio across all of theleads or in designated key leads. The recording timer and the settlingtimer may be executed by the rapid acquisition module utilizing a timercircuit, such as a 555 timer integrated circuit, or may utilize theclock associated with the processor 106.

The system 1 may further be configured to provide the clinician, oruser, with a means of overriding the automatic recording feature andforcing an immediate recording of and ECG dataset 40 of thepredetermined test duration, such as providing a button or location onthe user interface 14 through which the clinician can instruct immediaterecording.

FIG. 3 depicts one embodiment of a method 60 of monitoring ECG, such assteps carried out by executing the instructions of the rapid acquisitionmodule 11. At step 61, the impedance is measured for each electrode Atstep 63, it is determined whether all impedances are less than or equalto respective impedance thresholds. If not, then it is assumed that allelectrodes 6 are not yet connected to the patient, and the rapidacquisition module 11 awaits further impedance measurements until allimpedances are less than or equal to the impedance thresholds. Once theimpedance threshold requirements are met, initial ECG lead data isrecorded at step 65 and analyzed at step 66 to determine a noise levelin each lead. At step 67, the rapid acquisition module 11 determineswhether all noise levels are less than or equal to noise thresholds. Ifnot, then further initial ECG lead data is recorded and a noise levelassessed in each lead until all noise levels in the various leads areless than or equal to the respective one or more noise thresholds. Arecording timer is then started at step 69 and ECG data is recorded atstep 70. Step 71 determines whether all impedances remain less than orequal to the impedance thresholds, and step 72 determines whether allnoise levels remain less than or equal to the noise thresholds. Ifeither of those conditions are not met, then the recording timer isrestarted at step 69 and process begins again at step 70 with recordingnew ECG data. If, on the other hand, all impedances are maintained belowthe impedance thresholds and all noise levels are maintained below thenoise threshold, the rapid acquisition module 11 checks at step 73whether the recording timer has reached the test duration. If not, itcontinues to check the impedance levels and noise levels against therespective threshold until the test duration is reached. Once the testduration is reached at step 73, then the ECG data set has been recordedand is then stored at step 75. A completion alert is then provided atstep 77.

FIGS. 4A and 4B depict another embodiment of a method 60 of monitoringECG. Impedance values for each electrode are received at step 62, andall impedances are compared to impedance thresholds at step 63 asdescribed above. The impedance values are continually checked until allimpedances are less than or equal to the respective impedancethresholds. At that point, the settling timer is started at step 64 andinitial ECG lead data is recorded at step 65. A noise level isdetermined for the data in each lead at step 66, such as by calculatinga signal-to-noise ratio for each lead. The noise level for each lead isthen compared to a respective noise threshold at step 67 until all noiselevels are less than or equal to the noise thresholds. Step 68 assesseswhether the settling timer has reached the attempt duration, and if notthen a recording timer is started at step 69 and ECG data is recorded atstep 70. In the depicted embodiment, the ECG data is recorded for thetest duration, and once the recording timer equals the test duration atstep 73, the recorded data is analyzed to determined at step 74 whetherall noise levels remained less than or equal to the noise thresholds forthe test duration. For example, the signal-to-noise ratio for the datain each lead may be compared to threshold values to make thatdetermination. If the data exceeds the noise threshold requirement, thenthe rapid acquisition module 11 returns to step 68 to see if thesettling timer has reached the attempt duration. If not, then therecording timer is restarted and a new ECG dataset is recorded andassessed.

If an ECG data set that meets the noise threshold is not recorded duringthe attempt duration and the settling timer reaches the attempt durationat step 68, then a failure alert is generated at step 82. The recordingtimer is then started at step 69 a and ECG data is recorded at step 70 auntil the recording timer equals the test duration at step 73 a. In thissituation, the recorded data may then be accepted as the ECG dataset 40regardless of noise since a dataset meeting the noise threshold wasunable to be recorded.

Once the ECG dataset 40 is recorded, it is stored at step 75 and thesettling timer is stopped at step 76. A completion alert is provided atstep 77, such as an audio and/or visual alert provided via the userinterface 14. The ECG dataset is analyzed at step 78 and analysisresults are presented at step 79, such as on the display 15 of the userinterface 14. The clinician may then enter an acceptance or rejection ofthe ECG dataset 40 at step 80, such as via user interface 14. If arejection is received at step 80, then the rapid acquisition module 11may restart the settling timer at step 64 and re-execute the steps toassess the noise levels in each lead and attempt to re-record a reliableECG dataset 40. If, on the other hand, a rejection is not received atstep 80, then the method is completed, and the ECG dataset 40 andanalysis results are permanently stored, such as in the patient'smedical records. For example, the ECG monitoring system 1 may transmitthe ECG dataset 40 to a host network for the medical facility whichhouses patient medical records and/or an ECG database, such as a MUSEECG management system housing ECG waveform data and available by GeneralElectric Company of Schenectady, N.Y. Alternatively, the ECG dataset andanalysis results may be printed as a permanent graphical record or inaddition to electronic storage or transmission.

Returning to FIG. 2, one embodiment of the computing system 100 in themonitor 4 includes rapid acquisition module 11 executable to rapidlyacquire an ECG test of a specified duration as described herein. Thecomputing system 100 includes a processor 106, storage system 104,software 102, and communication interface 108. The processing system 106loads and executes software 102 from the storage system 104, includingthe rapid acquisition module 11. The rapid acquisition module 11includes computer-readable instructions that, when executed by thecomputing system 100 (including the processor 106), direct theprocessing system 106 to operate as described in herein in furtherdetail, including to execute the steps shown and described with respectto FIGS. 3 and 4A-4B.

Although the computing system 100 as depicted in FIG. 2 includes onesoftware 102 encapsulating one rapid acquisition module 11, it should beunderstood that one or more software elements having one or more modulesmay cooperate to provide the same operation. Similarly, while thedescription as provided herein refers to a single computing system 100and a processor 106, it is to be recognized that implementations of suchsystems can be performed using one or more processors, which may becommunicatively connected, and such implementations are considered to bewithin the scope of the description.

The processor 106 can comprise a microprocessor and other circuitry thatretrieves and executes software 102 from storage system 104. Processor106 can be implemented within a single processing device but can also bedistributed across multiple processing devices or sub-systems thatcooperate in executing program instructions. Examples of processor 106include general purpose central processing units, applications specificprocessors, and logic devices, as well as any other type of processingdevice, combinations of processing devices, or variations thereof.

The storage system 104 can comprise any storage media, or group ofstorage media, readable by processor 106, and capable of storingsoftware 102. The storage system 104 can include volatile andnon-volatile, removable and non-removable media implemented in anymethod or technology for storage of information, such ascomputer-readable instructions, data structures, program modules, orother data. Storage system 104 can be implemented as a single storagedevice but may also be implemented across multiple storage devices orsub-systems. For example, the software 102 may be stored on a separatestorage device than the ECG dataset 40. Storage system 104 can furtherinclude additional elements, such a controller capable of communicatingwith the processing system 106.

Examples of storage media include random access memory, read onlymemory, magnetic discs, optical discs, flash memory, virtual memory, andnon-virtual memory, magnetic sets, magnetic tape, magnetic disc storageor other magnetic storage devices, or any other medium which can be usedto storage the desired information and that may be accessed by aninstruction execution system, as well as any combination or variationthereof, or any other type of storage medium. Likewise, the storagemedia may be housed locally with the processing system 106, or may bedistributed in one or more servers, which may be at multiple locationsand networked, such as in cloud computing applications and systems. Insome implementations, the storage media can be a non-transitory storagemedia. In some implementations, at least a portion of the storage mediamay be transitory.

The communication interface 108 may comprise any elements and/orcircuitry necessary to communicate with the other devices in the system1, including the user interface 14 and the signal processing circuit112. The user interface 14 is generally any device, or group of devices,configured to provide information to the clinician, such as a visualdepiction of the ECG dataset 40, the completion alert 42, analysisresults 44, and failure alert 46. Furthermore, the user interface 14 isconfigured to receive input from a clinician or other user of the ECGmonitoring system 1, such as to include input selecting the testduration 34, attempt duration 36, and/or an acceptance or rejection 38of an ECG dataset 40. The user interface 14 may include any means forinputting such information. To provide just a few examples, the userinterface 14 may receive user input through a touch screen, such ascomprising the display 15, a mouse, a keyboard, a voice input device, atouch input device other than the touch screen, a visual input devicefor detecting non-touch motion and/or gestures by a user, an/or anyother comparable input devices and associated processing elementscapable of receiving input from a user, such as a clinician. Outputdevices include a display 15, which may be any video display orgraphical display, numerous embodiments of which are known and availablein the art. Output devices further include the speaker 17 for providingan audio alert to a clinician, such as part of the completion alert 42and/or the failure alert 46.

This written description uses examples to disclose the invention,including the best mode, and also to enable any person skilled in theart to make and use the invention. Certain terms have been used forbrevity, clarity and understanding. No unnecessary limitations are to beinferred therefrom beyond the requirement of the prior art because suchterms are used for descriptive purposes only and are intended to bebroadly construed. The patentable scope of the invention is defined bythe claims, and may include other examples that occur to those skilledin the art. Such other examples are intended to be within the scope ofthe claims if they have features or structural elements that do notdiffer from the literal language of the claims, or if they includeequivalent features or structural elements with insubstantialdifferences from the literal languages of the claims.

1-20. (canceled)
 21. An ECG monitoring system comprising: two or moreelectrodes configured to record cardiac potentials from a patient; atleast one processor; a rapid acquisition module executable on the atleast one processor to: start a settling timer, using the processor,once an impedance of the two or more electrodes is less than animpedance threshold; generate ECG lead data based on the cardiacpotentials; repeatedly assess the ECG lead data to determine whether anoise level requirement and an impedance level requirement have beenmet; identify an ECG dataset once the noise level requirement and theimpedance level requirement are met for at least a predetermined testduration; and once the settling timer reaches a predetermined attemptduration where the noise level requirement and the impedance levelrequirement have not been met for at least the predetermined testduration, reassess the ECG lead data generated during the attemptduration to identify at least one ECG dataset.
 22. The system of claim21, wherein the rapid acquisition module is further executable on theprocessor to modify at least one of the noise level requirement and theimpedance level requirement, wherein reassessing the ECG lead dataincludes determining whether the modified noise level requirement and orthe modified impedance level requirement have been met for at least thepredetermined test duration to identify at least one ECG dataset. 23.The system of claim 21, wherein the rapid acquisition module is furtherexecutable on the processor to receive a user-inputted test duration,wherein reassessing the ECG lead data includes determining whether thenoise level requirement and the impedance level requirement have beenmet for the user-inputted test duration to identify the at least one ECGdataset.
 24. The system of claim 21, wherein the rapid acquisitionmodule is further executable on the processor to stop the settling timeronce the ECG dataset is identified.
 25. The system of claim 24, whereinthe rapid acquisition module is further executable on the processor togenerate a failure alert after the settling timer reaches thepredetermined attempt duration.
 26. The system of claim 21, wherein theimpedance requirement includes that the impedance of at least a subsetof the electrodes remains less that the impedance threshold.
 27. Thesystem of claim 26, wherein the impedance requirement includes that theimpedance of all electrodes remains less that the impedance threshold.28. The system of claim 26, wherein the noise level requirement includesthat the noise level in at least a subset of leads is maintained belowthe noise threshold for a predetermined test duration while theimpedance requirement is met.
 29. The system of claim 21, wherein therapid acquisition module is further executable on the processor tocontinually determine whether the noise level requirement and theimpedance level requirement are met, and to identify the ECG datasetfrom the ECG lead data as soon as the noise level requirement and theimpedance level requirement are simultaneously met for the predeterminedtest duration.
 30. The system of claim 21, wherein the rapid acquisitionmodule is further executable on the processor to determine atpredetermined intervals whether the noise level requirement and theimpedance level requirement are met.
 31. A computer-implemented methodof monitoring ECG, the method comprising: determining that an impedanceof each of two or more electrodes is less than an impedance threshold;generating with a processor ECG lead data based on cardiac potentialsrecorded from the two or more electrodes; starting a settling timer withthe processor once the impedance of the two or more electrodes is lessthan an impedance threshold; repeatedly assessing the ECG lead data withthe processor to determine whether a noise level requirement and animpedance level requirement have been met; identifying an ECG datasetwith the processor once the noise level requirement and the impedancelevel requirement are met for at least a predetermined test duration;and once the settling timer reaches a predetermined attempt durationwhere the noise level requirement and the impedance level requirementhave not been met for at least the predetermined test duration,reassessing the ECG lead data generated during the attempt duration withthe processor to identify at least one ECG dataset.
 32. The method ofclaim 31, further comprising modifying at least one of the noise levelrequirement and the impedance level requirement, wherein reassessing theECG lead data includes determining whether the modified noise levelrequirement and or the modified impedance level requirement have beenmet for at least the predetermined test duration to identify at leastone ECG dataset.
 33. The method of claim 31, further comprisingreceiving a user-inputted test duration, wherein reassessing the ECGlead data includes determining whether the noise level requirement andthe impedance level requirement have been met for the user-inputted testduration to identify the at least one ECG dataset.
 34. The method ofclaim 31, further comprising receiving user input accepting or rejectingof the ECG dataset and, upon receiving a rejection, restarting thesettling timer and recording new ECG data for the predetermined attemptduration to identify at least one ECG dataset.
 35. The method of claim31, further comprising stopping the settling timer once the ECG datasetis identified.
 36. The method of claim 35, further comprising generatinga failure alert after the settling timer reaches the predeterminedattempt duration.
 37. The method of claim 31, wherein the impedancerequirement includes that the impedance of at least a subset of theelectrodes remains less that the impedance threshold and the noise levelrequirement includes that the noise level in at least a subset of leadsis maintained below the noise threshold for a predetermined testduration while the impedance requirement is met.
 38. The method of claim37, wherein the impedance requirement includes that the impedance of allelectrodes remains less that the impedance threshold.
 39. The method ofclaim 31, further comprising continually determining whether the noiselevel requirement and the impedance level requirement are met, and toidentify the ECG dataset from the ECG lead data as soon as the noiselevel requirement and the impedance level requirement are simultaneouslymet for the predetermined test duration.
 40. The method of claim 31,further comprising determining at predetermined intervals whether thenoise level requirement and the impedance level requirement are met.